Evaluate at least three (3) types of abuse or fraud that may occur during the course of medical coding and billing activities. Determine at least three (3) organizational policies and procedures that monitor such activities and critique the effectiveness of each policy/procedure.

Differentiate between the concepts of strategy and strategic management.
Apply analyses of internal and external environments to strategic planning.
Describe a business model and its component parts.
Understand the purposes of strategic alliances.
Describe the relationships among alliance motivation, structure, and outcomes.
Instructions

You are a healthcare executive of a large hospital, serving as director of health information. You have been advised that there are serious concerns regarding the competence of the facility’s billing and coding staff. To address these concerns, you will develop an action plan. Please complete your action plan as indicated below in Parts 1- 3.

 

Evaluate at least three (3) types of abuse or fraud that may occur during the course of medical coding and billing activities. Determine at least three (3) organizational policies and procedures that monitor such activities and critique the effectiveness of each policy/procedure.

 

 

(1)Based upon the trends of abuse or fraud that you identified in Part 1,  both a new employee orientation program and an ongoing training program for medical billing and coding employees. Design outlines of each training program and construct the learning activities involved. You should also indicate a leadership approach that you would use in the implementation of the programs.

 

(a)Develop a plan to evaluate the training programs at “time of launch” and again at periodic times over the next two (2) years. Describe the methods used to evaluate the effectiveness of each training program.

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